Provider Demographics
NPI:1316163009
Name:IWAHASHI, GORDON N (NCMMT)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:N
Last Name:IWAHASHI
Suffix:
Gender:M
Credentials:NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 N PALM AVE
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1843
Mailing Address - Country:US
Mailing Address - Phone:559-432-4339
Mailing Address - Fax:559-432-4328
Practice Address - Street 1:5707 N PALM AVE
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1843
Practice Address - Country:US
Practice Address - Phone:559-432-4339
Practice Address - Fax:559-432-4328
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist